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General NPI Number Information
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NPI Number | 1609565258
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Entity Type | Organization
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Legal Business Name | QUEEN CITY ORTHODONTICS
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 6752 CINCINNATI DAYTON RD STE 102A
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City | LIBERTY TOWNSHIP
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State | OH
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Zip | 45044-9325
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Country | US
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Telephone | 513-434-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 9856 SNIDER RD
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City | MASON
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State | OH
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Zip | 45040-9323
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Country | US
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Telephone | 567-454-0273
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Fax |
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Authorized Official
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Title or Position | ORTHODONTICS
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Name | NICOLE CRASTO
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Credential | DDS, MS
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Telephone | 567-454-0273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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